[Note: Topiramate is an anticonvulsant drug with FDA approval for treatment of seizure disorders and migraine prevention, and is sometimes prescribed off-label as an antidepressant.]

Background: Headaches are one of the most common neurological symptoms, and migraines are the most common primary headache disorder. The global prevalence of migraines is around 10% and the condition is associated with a high burden of disease.

Despite an abundance of good quality evidence, only 1 in 5 of patients who fulfill the criteria for preventive migraine therapy are appropriately treated.

Data on patient outcomes with preventive medication derive mostly from specialized academic centers, which contrasts with normal clinical practice where the majority of patients are treated outside tertiary care centers.

Objective: To explore tolerability, safety and efficacy outcomes of patients receiving topiramate for migraine prevention in a naturalistic setting.

Methods: After a 4-week prospective baseline, patients with a diagnosis of migraine according to International Headache Society criteria and eligible for migraine prevention were treated with flexible dosing of topiramate for 24 weeks (core phase), and optionally for a total of 48 weeks.

The primary safety analysis included adverse events (AEs) during the core phase.

For the main efficacy measures, the absolute changes from baseline to end of core phase as well as last follow-up visit were calculated for:

Some 74.1% of patients reported treatment emergent adverse events, most frequently paresthesias [“pins & needles”/numbness] (18.4%) and nausea (12.4%). Some 20.0% of patients withdrew from the study due to AEs.

• The mean number of migraine days per 4 week decreased from 6.2 +/- 3.9 days at baseline to 3.9 +/- 3.5 days at last core visit (P < .001).

• Consumption of triptans and analgesics reduced during the course of the core phase (P < .005).

• Fifty-one percent of all patients experienced at least a 50% reduction in migraine days during the core phase.

Conclusion:
Topiramate used for migraine prevention in non-academic institutions is generally safe, well tolerated and results in good control of migraine headaches and improvement in several aspects of quality of life.